*Actual Gross Household Income: This is the amount reported on the tax return of the parent(s) or guardian(s) of the student applicant, or your own for tax year 2012. Use either: the amount reported on line 37 of Form 1040 or the amount reported on line 21 of Form 1040A or the amount reported on line 4 of Form 1040EZ. If you request and are awarded financial assistance, you agree to supply us upon our request with the page of your tax return supporting the income reported here. Failure to supply us with documentation to support your request for financial assistance will result in a revocation of that assistance.

**Estimated Gross Household Income: This is the amount you expect to report on your 2013 tax return. We understand this is an estimate. We request this information to assess whether your request is based on anticipated changes to income. Describe any material change in the Special Circumstances section.